New ER Nurse - Feel Like Quitting Job

  1. Hi everyone. I recently started a position as a Staff Nurse in a ER in October. I graduated with my ASN in May 2015 and obtained my RN license in July 2015. Before starting in October in the ER, I worked from July 20-September 28 as a RN in a LTC facility. This ER is my first hospital job. I worked in a nursing home for two years before becoming a RN (worked as a LPN). I didn't really like LTC and wanted to work in a hospital really bad. I was so excited when I got the job. I was a fairly new RN, I only have my associates (I live in NYC and it's so hard to get a hospital job without a BSN) so I considered myself to be very lucky.

    So even though I have prior nursing home experience the hospital is like a whole new world to me. I started orientation during the first week of October. We were in the classroom part of orientation until the end of October. Then we were on the floor with a preceptor from November to the 1st week of December. We were told we were going to receive 3 months orientation. This never happened. I was hired for over night (7:15p-7:45a). Our orientation was only in days. When we transitioned to nights to continue our orientation, we didn't receive any. Our first night we were put alone. They gave us 1-2 rooms and said if we had any questions to ask another nurse. Then the next day we were completely on our own with our own assignment. And it has been like this ever since. We were still supposed to be on orientation but I believe they cut it short because they are so short staffed. Our head nurses or the director of the Ed who hired us never once told us we were being let off orientation early. We were never asked how we were doing. We were never even evaluated to see our status. I was so frustrated but I went along with it. I didn't complain or anything. But now I have gotten to a point where I get so overwhelmed. The other day I came on shift and was assigned 4 rooms. I had a ICU patient along with 6 other patients of varying ESI levels. I was so stressed out. I had to hang propofol for my pt and then I had all my other pts to worry about. And the triage nurses kept triaging more pts to me despite the fact that I already had a icu pt. In our Ed there is no set nurse-pt ratio or set number of rooms. But I think it's so unfair and unsafe. On regular icu units, the ratio is 1:2. From what I heard if we have a icu pt, we are only supposed to have 2 other stable Ed pts and that's it. But that's not happening here. The head nurse was aware of the whole situation and didn't do anything. I started crying at work and felt so embarrassed. The next day at work was no better. I again had a icu pt with 5 other pts and I kept getting more pts triaged to me. So now I don't know. I am honestly terrified of going back to work and see what awaits me. I have work tonight and am already saddened just by thinking about it. I want to quit. I know I just started and I am not even 3 months into this new job. What should I do? Also this is a city hospital. I'm afraid I might be burning bridges with all the other hospitals it is affiliated with. What should I do? Is this normal? How are things in your ED? And tips or advice would be really appreciated
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  2. 27 Comments

  3. by   ED Nurse, RN
    If you only had 4 rooms how did you have 6 patients? Have you spoken up to anyone about feeling overwhelmed? Asked for help? Spoken to the charge nurse? You need to communicate or people won't know what is going on. This is standard ER setting to me. Learn how to prioritize, know when to ask for help, and don't deflect your frustrations on other staff- like the triage nurse. Pts have to go somewhere, and if you have an open bed that is where they are going. The ER is a different beast and you can't compare yourself to what this floor does it what the ICU does. The ER's premise is get them in, get them dispo'd- very fast paced. I'd give it more time and speak up now. Not everyone is cut out to work in the ED, fair or not, this is just how it is, every where.
  4. by   RNboss_84
    Stay positive and hang in there. If you know that this is what you were meant to do then it will get better. I have been a nurse for 3 years and I just started an ER residency this past October myself. I don't have it as hard as you but there were days that I DREADED going to work. Even with my prior knowledge of nursing, I felt as if I was a bumbling fool that didn't know a thing. I broke down a couple of times and my preceptor was not very helpful or as supportive as she could be. But it has gotten better. The nurse to patient load is usually 4-5 patients and they designate nurses to do the triage in direct bedding (if we have the staff). Some days are still rough and I'm still learning, but it does get better. Prioritizing is def key, and I had to let go of the fact that everyone needs me urgent. If they aren't critical, it will just have to wait.


    As tough as it is, I know the ER is for me. I just have to get through this learning curve. I'm from the city so I know how hard it is to get a hospital job, esp in the ED. So get your experience and move on to a situation that you feel may be safer. You're not the first nurse to be overwhelmed and you won't be the last. Just know when you're done you'll be able to handle anything that comes your way. Best of luck to you!
  5. by   Altra
    Hi MichelleJ ... hope you're able to take a breather today.

    From reading your post, it seems you believe you were promised 12 weeks of orientation, but possibly only got (from my calendar guesstimate) 8 - 10. The classroom learning portion counts as orientation, and there is definitely an art to structuring an orientation that contains the right balance of experiential and didactic learning. While 12 - 16 weeks would unquestionably be better, and is recommended by the ENA, 8-week orientations are pretty common.

    A few comments:

    * In my experience, even in hospitals where there is either by policy or by union contract a set nurse to patient ratio for inpatient units ... that is simply not the case in the ER. It really can't be. If every nurse currently working was maxed in terms of ratio ... what would happen to the next patient to arrive? The ER doors never close.

    * Hallway patients are a fact of life in many ERs, at least during the busiest period of the day (often 11am - 11pm).

    * Mostly day schedules while on orientation are common, even for those hired as night shift staff. The reasons are pretty straightforward -- you as the orientee have more resources during the day, and the department has more resources to monitor your performance/progress as well.

    One thing I noted in your post is your repeated use of "we" ... so that tells me that you are in a cohort of two or more new nurses who were hired and oriented at the same time. Have you communicated with the others? Have you, as a group, communicated with your preceptor(s), educator, and/or manager for some clarification of the transition from orientee to regular staff?

    While your previous experience as an LPN in LTC is valuable -- juggling multiple priorities, managing family concerns, caring for patients with multiple comorbidities - the rhythm of the day in LTC is not ever going to be present in an ER, so it's time to let go of that as a mental yardstick.

    A previous poster brought up whether or not you had asked for help - and that is a valid question. Teamwork is essential in the ER. As charge nurse, I expect newer staff to err on the side of checking in with me more frequently rather than not frequently enough. While I can glean a lot from the tracking board and from observation -- you help yourself and your patients if you proactively seek out feedback and help with prioritization and delegation.

    I hope some of this info is helpful. The ER can definitely be overwhelming - it's not a sign of failure that you feel that way just 12 weeks in. Communicate, advocate for yourself, and stay positive! Keep checking in and let us know how you're doing!
  6. by   emtb2rn
    Quote from ED Nurse, BSN RN
    If you only had 4 rooms how did you have 6 patients?.
    Easy, 4 rooms plus 2 in the hallway. Commonly occurs on days that end in a "y".
  7. by   Anna Flaxis
    I find that often, especially for new grads, it's not a "safety" issue so much as a confidence issue. You just don't THINK you can handle what you really CAN handle.

    At the same time, new grads do need a lot of hand-holding that a lot of departments can't afford, because they need bodies out on the floor NOW.

    As a result, these "sink or swim" situations are exceedingly common.

    Personally, I do well with sink or swim. But I recognize that one size does not fit all.

    My personal opinion, based on what you have posted, is that you should try to find a more supportive environment to first learn how to be a nurse- then, once you have your feet on the ground, transfer to something more specialized. I hate to tell new grads to cut their nursing teeth in Med/Surg, because IMO, Med/Surg *IS* a specialty- and it's not fair to that specialty to use them as a stepping stone or training ground for people that don't really want to be there.

    And yet, at the same time, Med/Surg units are really fertile learning grounds from which to step off into something more specialized once you've learned the basics of nursing, such as head to toe assessment, pathophysiology and pharmacology, the "soft" skills of therapeutic communication, and of course, prioritization and time management.

    There is absolutely no shame in admitting that you need more nursing experience before starting in the ED, and while I respect M/S nursing for its role as a specialty, there is no better learning ground for those who want a solid foundation before they make the leap into an area such a ED or ICU.
  8. by   Julia77
    Is there another RN who is experienced who could mentor you unofficially? I had a guardian angel nurse totally help me with this situation in ED where I was absolutely drowning, and I will forever be grateful to her. She said I was her baby bear...
    I agree with the need to reach out for help, but you need to be choosey about this so that you get supportive and helpful help, not backbiting help who will use your request against you. ED does involve different prioritization. I transitioned from ICU to ED and had a very challenging experience.
    Julia
  9. by   Lev <3
    I think you need to grow a backbone. You need one to survive in the ER environment. Crying at work will not help. You need to start refusing assignments by making the people throwing these patients at you understand why it is a very bad idea for you to have any more patients at this current time. I.e. "We just intubated 7 and she needs more lines and I have a boatload of charting to do. I can't see any other patients until I catch up. Is there anywhere else this patient can go? If you really have to send them, send them but I may not be able to see them for a while."

    Midway through they should start wavering. Unless your staffing is THAT bad. More likely, the people she is buddy buddy with are being let off easy and you are being thrown all these patients.
  10. by   Iknowwha2du
    No matter where you go to work...you will most likely be pushed to the max...this is the nursing field..and having to deal with more than you think you should is very common. Speaking out about it can be a good thing and a bad thing because sometimes people may take you wrong..like feel you aren't confident or strong enough to handle the job...on the other hand if you bite off more then you can chew and don't do well..the place will say, why didn't you say something..it is all a big game and you need to know how to play it...but being new and not giving something enough time...and or not asking the right questions can go against you at times. However just ask the right questions and don't come across as if you can't handle the environment at all. Be specific and make a point that you can't handle the job..you just need time to work on certain things. Good luck!
  11. by   OldDude
    Once you transition from your relaxed daytime orientation, accompanied by your educator and various administrators in their dress clothes you enter into your "nights in the ER orientation" - which is exactly what you are experiencing. There isn't a such a thing as a night shift ER new employee orientation - other than what exists on paper.
  12. by   AZQuik
    Quote from OldDude
    Once you transition from your relaxed daytime orientation, accompanied by your educator and various administrators in their dress clothes you enter into your "nights in the ER orientation" - which is exactly what you are experiencing. There isn't a such a thing as a night shift ER new employee orientation - other than what exists on paper.
    I disagree. Plenty of hospitals orient on one shift and then someone spends the last few weeks on their soon to be primary shift. I was oriented for 6 months. 5 were on nights. Maybe it's not your experience but it does happen
  13. by   xxMichelleJxx
    Quote from ED Nurse, BSN RN
    If you only had 4 rooms how did you have 6 patients? Have you spoken up to anyone about feeling overwhelmed? Asked for help? Spoken to the charge nurse? You need to communicate or people won't know what is going on. This is standard ER setting to me. Learn how to prioritize, know when to ask for help, and don't deflect your frustrations on other staff- like the triage nurse. Pts have to go somewhere, and if you have an open bed that is where they are going. The ER is a different beast and you can't compare yourself to what this floor does it what the ICU does. The ER's premise is get them in, get them dispo'd- very fast paced. I'd give it more time and speak up now. Not everyone is cut out to work in the ED, fair or not, this is just how it is, every where.
    Each room can hold up to two pts. I had pts in my rooms as well as pts in the hallway. And no I didn't have a "empty bed". Even if there's no space, the pt will be brought and placed in a stretcher in the hallway. I am upset because we were told if we have a icu pt we will be given up to 2 stables pts and that's it. That wasn't happening. The charge nurse was present and aware of what was going on. I am also upset because during my month orientation on the unit I never took care of a icu pt. so this was a first. There was so much things that I never did. Hang propofol, dopamine. It was a mess and the lack of experience doing everything made me even more nervous. You're right not everyone is cut out to work in a ED. Maybe as a new RN I shouldn't have accepted a ED position. Idk
  14. by   xxMichelleJxx
    Quote from Anna Flaxis
    I find that often, especially for new grads, it's not a "safety" issue so much as a confidence issue. You just don't THINK you can handle what you really CAN handle.

    At the same time, new grads do need a lot of hand-holding that a lot of departments can't afford, because they need bodies out on the floor NOW.

    As a result, these "sink or swim" situations are exceedingly common.

    Personally, I do well with sink or swim. But I recognize that one size does not fit all.

    My personal opinion, based on what you have posted, is that you should try to find a more supportive environment to first learn how to be a nurse- then, once you have your feet on the ground, transfer to something more specialized. I hate to tell new grads to cut their nursing teeth in Med/Surg, because IMO, Med/Surg *IS* a specialty- and it's not fair to that specialty to use them as a stepping stone or training ground for people that don't really want to be there.

    And yet, at the same time, Med/Surg units are really fertile learning grounds from which to step off into something more specialized once you've learned the basics of nursing, such as head to toe assessment, pathophysiology and pharmacology, the "soft" skills of therapeutic communication, and of course, prioritization and time management.

    There is absolutely no shame in admitting that you need more nursing experience before starting in the ED, and while I respect M/S nursing for its role as a specialty, there is no better learning ground for those who want a solid foundation before they make the leap into an area such a ED or ICU.
    I was actually considering speaking to the nursing director of the ED. She hired me but I'm afraid to ask her cause I think she might get upset. She is always saying how they are short staffed and I feel me asking to leave may not fly so well with her? I don't know what to do. I'm so confused. I know working in a ER is a great opportunity that not every own gets. But the fact is that I don't feel I was adequately trained to learn what I need to. And I can't blame the preceptors that I had either because they were so busy themselves. I think working in a slower environment like you mentioned med surg might be better for me to learn. But idk if my director will allow it. I've heard that sometimes she gives people a hard time when they try to transfer

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